Weight Gain During Pregnancy
When I was 20 weeks pregnant, a doctor told me I should “slow down” my weight gain. Here’s why I think doctors need to be more considerate when addressing weight gain during pregnancy.
Weight gain during pregnancy — it’s a sensitive subject. On the one hand, we want to protect babies from the detrimental effects of disorders associated with excessive weight gain such as gestational diabetes and preeclampsia. On the other hand, I believe obstetricians have become overly cautious about what is often normal, healthy growth.
In some cases, this hypervigilance is merely disheartening to a woman trying to embrace her changing body, in other cases, it could lead to a full-fledged spiral with harmful outcomes for both her and her unborn baby.
WEIGHT GAIN DURING PREGNANCY AND EATING DISORDERS
The thing is, pregnancy is not the time to make a woman feel bad about her weight. Studies suggest that as many as 75% of American women have disordered eating behaviors or report symptoms of eating disorders. Meanwhile, women with a history of eating disorders have higher rates of miscarriage, small for gestational age babies, low birth weight babies, babies with microcephaly, intrauterine growth restriction, and premature labor.
If you subscribe to an intuitive eating food philosophy, then you know that dieting and obsessing about weight frequently leads to disordered eating behaviors, and in extreme cases, eating disorders.
So you would think that it would be a top priority for OBs to avoid making their pregnant patients feel bad about their weight gain. You’d think they’d be sensitive when dealing with a population so susceptible to the harms of diet mentality. But shockingly, this is something that is all too common.
WHEN YOUR OB SAYS YOU’RE GAINING TOO MUCH WEIGHT
At my 20-week ultrasound during my recent pregnancy, I was overcome with joy to see my baby on the monitor. As we gushed over a photo of him sucking his tiny thumb in utero, the doctor happily informed us that our little boy looked healthy and everything was progressing normally. Then she switched gears.
“How much weight have you gained so far?” she asked.
“About 15 pounds,” I responded.
“Well, you might want to slow down a little,” she remarked.
I could feel my blood start to boil. “Why is that?” I asked.
“Well, we just want to make sure you don’t gain too much,” she explained. “You don’t want to have to push out a 10-pound baby.”
She then proceeded to tell us that Caleb was on the larger side of normal – landing in the 90th percentile for size.
“How have you been eating,” she continued to prod (a question any dietitian would naturally take offense to).
I politely informed her that I wasn’t “eating for two” – as she so kindly informed me wasn’t an appropriate dietary strategy (duh) – and that I continued to eat the same well-balanced, predominantly plant-based foods I’d eaten prior to pregnancy. I enjoyed treats here and there (#balance) but nothing out of the ordinary.
She suggested I start taking nightly walks. Had I not been so incensed at this point, I would have laughed. I was still doing 4-5 hour-long studio workouts per week at this point.
My husband could sense the wrath of Whitney beginning to rise and we quickly wrapped up the appointment.
When we got to the car, I unloaded. I’m a dietitian, an avid exerciser, and thankfully, I’d been feeling pretty good about my body and weight so far – who the $#@% was she to come at me with that? My husband sympathized with my frustration but I could tell he was also a little concerned. I mean, if a doctor tells you there’s a problem…
NORMAL WEIGHT GAIN RECOMMENDATIONS DURING PREGNANCY
The real problem, I believe, is how we define healthy weight gain during pregnancy.
The current recommendations for weight gain during pregnancy are:
- Underweight: 28-40 lbs
- Normal weight: 25-35 lb
- Overweight: 15-25 lbs
- Obese: 11-20 lbs
This weight comes from the fetus, expansion of maternal tissues, increases in uterine and mammary tissue mass, expansion of maternal blood volume, extracellular fluid, fat stores, and possibly other tissues.
The biggest issue is that these recommendations are simply averages and they don’t reflect the high degree of weight gain variability in pregnant women.
For example, the retention of extracellular fluid is highly variable in pregnancy; some women accumulate more than 5 liters – or 11 lbs!
These recommenations were derived from a review done by the Institute of Medicine’s Committee on Nutritional Status During Pregnancy and Lactation in 1990. They looked at data from a variety of studies on pregnant women from multiple populations and tried to identify commonalities.
However, weight gain in each of the studies varied substantially, and the “coefficients of variation” of weight gain for women with normal prepregnancy weights ranged from 31 to 63%. A coefficient of variation represents the range of values from the average. So, 63% means that many women’s weights were well above or below the average.
PROBLEMS WITH THE IOM’S WEIGHT GAIN RECOMMENDATIONS
According to the paper, “This degree of variation in gain after controlling for differences in maternal body size shows that maternal prepregnancy weight-for-height status accounts for only a small part of the variation in weight gain.”
In the “clinical implications” section of the report, the IOM explicitly states, “Therefore, recommended gains should be used only as targets and for identifying individuals who should be evaluated for insufficient or excessive rates of gain.”
Evaluation is the key word here, not implementation. Doctors should use these numbers as a reference, not a rule.
When evaluating a patient, there are SO MANY other factors to take into consideration before making a recommendation.
What is the patient’s weight history? What are their lifestyle habits? Does this patient have any medical conditions? How are their lab values? Does this patient have a history of eating disorders?
The problem is that many doctors simply look at one number — weight gain since the start of pregnancy – and immediately make a conclusion based on this single number.
When reviewing the IOM report, a few other things caught my attention.
One, pre-pregnancy weight-for-height status was usually based on recalled prepregnancy weight and on height measured at the first prenatal visit. If women were incorrect in these recalls, it certainly would affect the outcomes.
I also noticed that frame size and body fat weren’t taken into account. Weight and height are only two pieces of the puzzle when it comes to body composition.
Lastly, weight gain during pregnancy is not as linear as doctors would have you believe. The report showed that average weight gain was about 1 lb per week during the second trimester and 0.9 lbs during the third trimester. That’s not a huge difference, but it does show that slightly more weight is gained in the middle of pregnancy versus the end.
LOW BIRTH WEIGHT VS HIGH BIRTH WEIGHT BABIES
As it turns out, it’s actually better to have a bigger baby than a smaller one. Studies show that low birth weight babies have more birth complications and reach developmental milestones later than larger birth weight babies.
Therefore, you would think that doctors would be more concerned with the fetus gaining weight than with controlling it.
DANGERS OF DIETS DURING PREGNANCY
I’m not the only healthy woman that has been subjected to this. I’ve heard similar stories from many women — some who were actually underweight prepregnancy.
Even someone without an eating disorder would naturally be affected by these comments and start to question themselves.
Am I not doing enough? Should I be exercising more? Should I start counting calories? This is a dangerous line of questioning.
Dieting during pregnancy is a huge no-no according to every major medical association. Dieting during pregnancy has the potential to result in dietary deficiencies of important nutrients for babies like iron, folic acid, and omega-3 fatty acids which could result in poor growth and development or birth complications.
I fully understand that in evaluating a pregnant woman’s health status, a doctor should ask about diet and exercise. But is there perhaps a more sensitive way of doing so that wouldn’t provoke unhealthy thought patterns or behaviors?
Food for thought.
If you’re wondering, I ended up gaining 37 pounds during my pregnancy – a whopping two pounds over the recommendation. Also, Caleb was a week early.
He weighed in at 6 lb 10 oz, on the lower end of the normal 6-9 lb range.
By the time I got home from the hospital, I’d dropped about 27 of those pounds, likely from the babe and a ton of fluid.
Did you hear about my water breaking in Trader Joes? There was a lot of it!
Not that any of that matters, because as you’ve just learned, weight gain and loss during and after pregnancy are highly variable. We’re all so different and we can’t be pigeonholed into neat little weight gain categories. All that matters, in the end, is that we have a healthy baby.
It seems to me that pregnant women are much more likely to end up with a healthy baby if their mindset is fostered by positive messages instead of misguided dietary advice.
So if you’re like me, or many other women I know who have been unnecessarily badgered about their weight gain during pregnancy, know that:
- You’re not alone.
- If you’re practicing healthy pregnancy habits, your weight gain is probably just fine.
Are you wondering if you’re eating an adequate pregnancy diet? Check out my video: 5 Tips for Proper Prenatal Nutrition.
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Weigh in: If you’ve had a child, how did you feel about your weight gain during pregnancy?
*Fyi — the doctor in this story was not my main OB who birthed our son (she is amazing). This was a doctor I only saw once for my ultrasound.